Highmark - Seating Made Simple

Shipping Information

*Company Name
*Contact Name
*Address
*City		*State	*Zip
*Phone	e.g. 800-777-1234
*Fax	e.g. 800-777-1235
*Email	Needed to send your confirmation.

Job Information
*Highmark Job No.	(information located on the label underneath the seat)

Problem Information
*Problem Statement	Please specify the quantity in order to process the replacement order.


Optional Information
Upload Image(s): Use this option to provide pictures of the defective component(s).
File 1
File 2
File 3
File 4
File 5
* Required field. RA process will be delayed without required information. Labor reimbursement will be approved for up to 2 hours at $20 per hour and only apply to requests made within six months from the original ship date. Reimbursement does not include the drive time.